Association of baseline three-dimensional lesion volumes with two-year patient-reported visual function after anti-vascular endothelial growth factor therapy in neovascular age-related macular degeneration

This prospective cohort study tested whether baseline three-dimensional optical coherence tomography (OCT) and OCT angiography (OCTA) lesion volumes are associated with patient-reported visual function after anti-vascular endothelial growth factor (anti-VEGF) therapy in neovascular age-related macular degeneration (nAMD). Ninety-two treatment-naïve nAMD eyes underwent volumetric segmentation of their baseline lesion components, including vascular subretinal hyper-reflective material (vSHRM), avascular subretinal hyper-reflective material (avSHRM), subretinal fluid, intraretinal fluid, and serous pigment epithelial detachment. The National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) was administered at the 2-year visit. Univariate standardized regressions across 36 biomarker–subscale pairs were corrected for multiple testing with the Benjamini–Hochberg false discovery rate (FDR). Three univariate associations survived FDR correction (q < 0.05). In multivariate analysis, baseline vSHRM volume was independently associated with a worse VFQ-25 composite score (standardized β = −0.366, p = 0.001), and baseline avSHRM volume was independently associated with a worse near activities score (standardized β = −0.370, p < 0.001), adding 8.0% and 11.9% incremental variance beyond clinical covariates. Baseline vSHRM and avSHRM volumes thus add prognostic information about patient-reported visual function beyond best-corrected visual acuity and clinical covariates. This study was registered in Chinese Clinical Trial Registry ( www.chictr.org.cn/showproj.html?proj=173189 ; ID: ChiCTR2200063428; date of registration: 2022-09-06).